MEDICARE: YUJIA YAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	100258	CA

General Provider Information

NPI Number	:	1023467735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUJIA YAO

Provider Business Mailing Address
First Line	:	1670 WESTWOOD DR STE J
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5111
Country	:	US
Telephone Number	:	408-826-4676
Fax Number	:	408-826-4554

Provider Business Practice Location Address
First Line	:	1670 WESTWOOD DR STE J
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5111
Country	:	US
Telephone Number	:	408-826-4676
Fax Number	:	408-826-4554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2016
Last Update Date	:	01/18/2022

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